Psychological variables associated with outcome of spinal cord stimulation trials

Study Design. This is a prospective study designed to identify psychological factors associated with response to spinal cord stimulation (SCS) trial. Summary of Background Data. In most centers, implantation of a permanent SCS system is preceded by a trial of a temporary stimulating electrode. Yet, even among those who report greater than 50% pain reduction during trial, a significant number of these patients fail to receive long-term pain relief from the permanent system. Because mood disorders can alter pain report, we hypothesized that refined definition of the psychological factors associated with SCS success could result in improved selection of candidates for SCS trial. Methods. The study sample consisted of 43 chronic pain patients (72% failed back surgery syndrome, 77% with radiating low back pain) who were referred for implantable pain management. Following psychological evaluation, patients were admitted for a three-day inpatient trial of SCS. Report of at least 50% pain relief during trial was considered a success and resulted in implantation of the permanent stimulator. Patients were retrospectively divided into two groups: those whose pretrial pain was relieved by at least 50% ("success") and those whose pain was relieved by less than 50% ("failure"). Results. Univariate t-test or chi-square analyzes of group means of an extensive psychological battery followed by a global, stepwise logistic regression model of trial outcome was used to analyze between group results of a psychological test battery. MMPI depression and mania subscores were found to be significantly elevated among the two outcome groups (p = 0.007 and 0.025, respectively). Conclusions. Patient mood state is an important predictor of trial outcome. Specific indicators of SCS trial outcome are the MMPI depression and mania subscale scores with successful trials being associated with individuals who are less depressed and have higher energy levels.